Renal carcinoma: diagnosis of venous invasion with Gd-enhanced MR venography

Laissy, Jean Pierre; Menegazzo, David; Debray, Marie Pierre; Toublanc, M.; Ravery, Vincent; Dumont, Éric; Schouman-Claeys, É.

doi:10.1007/s003309900296

Cited by 47 publications

(15 citation statements)

References 24 publications

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“…Various techniques have been described for tumor thrombectomy in RCC depending upon the level of the thrombus (table 3) [19][20][21]. Mortality rates of 6-9% have been reported after surgery in patients with extension of the thrombus in IVC with major causes of death being pulmonary embolism and myocardial infarction or related to cardiopulmonary bypass [4,12]. We had an operative mortality of 3.4% in our patients, and this low mortality may be due to the fact that the majority of patients (80%) had infrahepatic tumor thrombi.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Imaging and Thrombus Level in Management of Renal Cell Carcinoma Extending to Veins

Gupta

Ansari²,

Khaitan³

et al. 2004

Urol Int

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Objectives: To evaluate the role of newer imaging modalities in the diagnosis and evaluation of management according to extent of renal vein (RV) or inferior vena cava (IVC) thrombi in patients with renal cell carcinoma. Material and Methods: Fifty-nine patients with renal cell carcinoma and tumor thrombus extension into the RV or IVC were studied. Diagnosis was based on contrast-enhanced CT, magnetic resonance imaging or color-Doppler ultrasonography. Surgical treatment was contemplated in 42 suitable patients and complete resection could be done in all but 3 cases. Results: There were 48 males and 11 females with mean age of 51.8 years. Isolated RV involvement was seen in 27 cases whereas IVC extension was present in 32 cases. The thrombus extent was infrahepatic in 62.5% (20/32) patients with IVC extension. With the newer imaging modalities like contrast-enhanced CT, color-Doppler ultrasound and/or magnetic resonance imaging, correct diagnosis of the extent of the thrombus was possible in 95% of the patients. The accuracy of color-Doppler ultrasound was same as magnetic resonance imaging in the evaluation of the extent of the thrombus. In the present series a median follow-up of 4 years revealed a high incidence of local and distant recurrences and decreased survival in patients presenting with advanced disease, who had venous wall invasion. Conclusions: The extent of RV or IVC thrombi can be accurately diagnosed with contrast-enhanced CT scan and in case of doubt color-Doppler ultrasound is a good alternative to magnetic resonance imaging. Management can be planned according to the level of the tumor thrombus. Invasion of the venous wall was found to be a bad prognostic factor affecting survival.

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Section: Discussionmentioning

confidence: 99%

“…In renal cell carcinoma (RCC) the incidence of renal vein (RV) and inferior vena cava (IVC) involvement has been reported to be 10-30 and 4-10%, respectively [1][2][3][4]. The preoperative assessment for the presence and extent of RV and IVC tumor thrombi is an important step in the planning of an appropriate surgical resection approach.…”

Section: Introductionmentioning

confidence: 99%

Impact of Imaging and Thrombus Level in Management of Renal Cell Carcinoma Extending to Veins

Gupta

Ansari²,

Khaitan³

et al. 2004

Urol Int

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“…Approximately 23% of RCC invade the renal veins and 7% invade the inferior vena cava (17). Accurate definition of the presence and level of tumor thrombus preoperatively is critical for surgical planning and patient counseling.…”

Section: Discussionmentioning

confidence: 99%

The accuracy of multidetector Computed Tomography for preoperative staging of renal cell carcinoma

et al. 2012

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ARTICLE INFO _________________________________________________________ ___________________Purpose: The purpose of this study was to evaluate the accuracy of multidetector computed tomography (MDCT) in the preoperative staging of renal cell carcinoma (RCC). Materials and Methods:We retrospectively reviewed the clinical and pathological records of 312 patients with RCC who underwent staging MDCT before surgery. Radiographic findings were compared to the findings at surgery and pathological examination. All staging used 2009 updated TNM classification. Results: The difference in tumor size between radiographic and pathological findings was 0.21cm. In T1a group, the difference was 0.33cm. Agreement between MDCT and histopathological findings was moderate for T staging (Kappa = 0.469), fair for N staging (Kappa = 0.322), and excellent for M staging (Kappa = 0.932). The sensitivity and specificity of MDCT in detecting perinephric fat invasion were 32.26% and 85.87%, in detecting tumor thrombosis were 84% and 100%, in detecting adrenal gland invasion were 60% and 95.79%, in detecting lymph node involvement were 50% and 96.36%, in detecting distant metastasis were 100% and 99.67%, respectively. In regard to stage grouping, 237 of 314 patients were correctly staged by MDCT, with an overall accuracy of 75.48%. Conclusions: MDCT with a dynamic contrast protocol is able to delineate RCC with high accuracy. However, a great portion of tumors were overstaged by MDCT because of overestimation of tumor size and poor visualization of infiltration of the perinephric fat. In addition, nodal metastatic lesion evaluation relies on node size only and remains a difficult task.

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“…We believe magnetic resonance imaging (MRI) is the most sensitive test for determining cranial extent of venous involvement [18]. MRI also differentiates bland thrombus from tumor, avoids use of ionic contrast, and provides coronal and sagittal images for surgical planning [18][19][20]. For equivocal cases, transesophageal echocardiography (TEE) can assess the cephalad extent of tumor and denote hepatic vein involvement.…”

Section: Clinical Presentation and Preoperative Assessmentmentioning

confidence: 98%

Surgical management of renal cell carcinoma invading the vena cava

Gettman

Blute

2002

Curr Urol Rep

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Surgery remains the most effective treatment for renal cell carcinoma (RCC) invading the vena cava. Removal of tumor involving the vena cava or atrium may be challenging, but a thorough preoperative assessment and careful surgical technique have enhanced safety of resection and improved outcome. Preoperative imaging is essential for effective surgical intervention. Tumor extension into the vena cava does not adversely influence outcome in most reports. Characteristics of the primary tumor, including grade, perinephric fat invasion, lymph node involvement, and metastases, dictate outcome. Metastases are not an absolute contradiction to surgery, given the encouraging results with adjuvant immunotherapy. Nonetheless, improved methods for appropriate patient selection and new adjuvant therapies are needed to complement surgical intervention.

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Renal carcinoma: diagnosis of venous invasion with Gd-enhanced MR venography

Cited by 47 publications

References 24 publications

Impact of Imaging and Thrombus Level in Management of Renal Cell Carcinoma Extending to Veins

Impact of Imaging and Thrombus Level in Management of Renal Cell Carcinoma Extending to Veins

The accuracy of multidetector Computed Tomography for preoperative staging of renal cell carcinoma

Surgical management of renal cell carcinoma invading the vena cava

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